Current Options for the Pharmacotherapy of Obesity

2019 ◽  
Vol 25 (18) ◽  
pp. 2019-2032 ◽  
Author(s):  
Ioanna Gouni-Berthold ◽  
Heiner K. Berthold
Keyword(s):  
Safety Profile ◽  
Energy Homeostasis ◽  
Therapeutic Option ◽  
Health Care Systems ◽  
Lifestyle Changes ◽  
Safety Issues ◽  
The Us ◽  
Care Systems ◽  
Obesity Drugs ◽  
Very High

650 millions of adults are obese worldwide - in the US alone, forty percent of the adults are obese. Although the obesity pandemic is constantly expanding at very high costs for health care systems, the currently available options of pharmacotherapy for obesity are rather limited. Despite intensive research efforts, the vast majority of the anti-obesity drugs developed up to now have a rather limited efficacy and/or safety profile. In the last fifty years, various drugs reached advanced states of clinical development but were either never marketed or were initially approved but withdrawn later due to safety issues. However, the understanding of the pathophysiology of obesity has been steadily improving and new, promising drugs targeting various selective obesityassociated and energy-homeostasis-related pathways are now available. When lifestyle changes alone fail to combat, then additional pharmacotherapy with an acceptable efficacy and safety profile could provide a useful therapeutic option.

scholarly journals Identification and management of prediabetes: results of the Latin America Strategic Prediabetes Meeting

2017 ◽  
Vol 41 ◽  
pp. 1 ◽  
Author(s):  
Patricio López-Jaramillo ◽  
Ramfis E. Nieto-Martínez ◽  
Gestne Aure-Fariñez ◽  
Carlos O. Mendivil ◽  
Rodolfo A. Lahsen ◽  
...  
Keyword(s):  
Latin America ◽  
Health Care Systems ◽  
Public Health Problem ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Lifestyle Changes ◽  
Diagnosis And Treatment ◽  
Effective Interventions ◽  
The Status ◽  
Care Systems

To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 – 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level.

Understanding Parents’ Approaches to Care and Treatment of Children With Cancer When Standard Therapy Has Failed

2007 ◽  
Vol 25 (17) ◽  
pp. 2414-2419 ◽  
Author(s):  
Myra Bluebond-Langner ◽  
Jean Bello Belasco ◽  
Ann Goldman ◽  
Carmen Belasco
Keyword(s):  
Pediatric Oncology ◽  
Standard Therapy ◽  
Participant Observation ◽  
Health Care Systems ◽  
Ethnographic Study ◽  
Semistructured Interviews ◽  
The Us ◽  
Care Models ◽  
Care Systems ◽  
Care And Treatment

Purpose To examine US and United Kingdom (UK) parents’ approaches to care and treatment when standard therapy has failed and consider implications for clinical practice. Methods We conducted a prospective, ethnographic study of parents, patients, and staff, including participant-observation; open-ended, semistructured interviews; and review of medical records at a US and UK pediatric oncology center. Thirty-four children (n = 17 US, 17 UK), whose disease had recurred with less than 30% chance of cure, were enrolled between March 2001 and June 2002 and followed until death (n = 11 US, 14 UK) or close of study in December 2005 (n = 6 US, 3 UK). Results There were no major differences between parents’ approaches in the US and UK despite differences in health care systems, institutions, and parents’ religion or ethnicity. All parents continued to have or request meetings with the oncologist and investigative procedures. No parent initiated discontinuation of cancer- or symptom-directed interventions. In 28 of 34 cases (13 US, 15 UK), parents continued to pursue cancer-directed therapies; in 16 of 28 cases (seven US, nine UK), parents initiated inquires beyond what was offered. Conclusion Understanding parents’ behavior requires attention to the reason and emotion they bring to decision making and their children's care, their unique responsibilities as parents, and what they learn throughout the illness. Parents do not see cancer-directed therapy and symptom-directed care as mutually exclusive, alternative approaches. Parents will not be constrained by what the oncologist offers. Physicians and parents discuss and negotiate care and treatment throughout the illness. Our findings suggest developing integrative care models incorporating cancer-directed, symptom-directed, and supportive care throughout the illness; they are most consistent with parents’ approaches and advances in pediatric oncology.

scholarly journals Robotics in Gynecology: Why is this Technology Worth pursuing?

2013 ◽  
Vol 7 ◽  
pp. CMRH.S10850 ◽  
Author(s):  
Rodrigo Ayala-Yáñez ◽  
Emilio José Olaya-Guzmán ◽  
Javier Haghenbeck-Altamirano
Keyword(s):  
Health Care Systems ◽  
Da Vinci Surgical System ◽  
Training Design ◽  
Oncologic Surgery ◽  
Novel Technologies ◽  
The Us ◽  
Care Systems ◽  
Vinci Surgical System ◽  
Positive Effect ◽  
Surgical System

Robotic laparoscopy in gynecology, which started in 2005 when the Da Vinci Surgical System (Intuitive Surgical Inc) was approved by the US Food and Drug Administration for use in gynecologic procedures, represents today a modern, safe, and precise approach to pathology in this field. Since then, a great deal of experience has accumulated, and it has been shown that there is almost no gynecological surgery that cannot be approached with this technology, namely hysterectomy, myomectomy, sacrocolpopexia, and surgery for the treatment of endometriosis. Albeit no advantages have been observed over conventional laparoscopy and some open surgical procedures, robotics do seem to be advantageous in highly complicated procedures when extensive dissection and proper anatomy reestablishment is required, as in the case of oncologic surgery. There is no doubt that implementation of better logistics in finance, training, design, and application will exert a positive effect upon robotics expansion in gynecological medicine. Contrary to expectations, we estimate that a special impact is to be seen in emerging countries where novel technologies have resulted in benefits in the organization of health care systems.

Modifiable Risk Factors for Stroke and Strategies for Stroke Prevention

2017 ◽  
Vol 37 (03) ◽  
pp. 237-258 ◽  
Author(s):  
Amytis Towfighi ◽  
Valerie Hill
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Stroke Prevention ◽  
Health Care Systems ◽  
Dose Intensity ◽  
Lifestyle Changes ◽  
Theoretical Frameworks ◽  
Middle Income ◽  
Modifiable Factors ◽  
Care Systems

AbstractThe pathophysiology of stroke is well characterized, and 9 out of 10 strokes are due to modifiable factors. However, preventive strategies thus far have been relatively ineffective in curbing the global stroke burden, which is projected to increase given the aging of the world's population and epidemiological transition in many low- to middle-income countries. In this review we will summarize our current understanding of behavioral, environmental, and metabolic stroke risk factors not covered elsewhere in this issue. Specifically, we will review the evidence for environmental and household air pollution, smoking, and alcohol use. We will subsequently provide a conceptual framework for stroke prevention strategies, categorizing them as those aimed at changing health care systems and/or provider behavior and those targeting behaviors of patients and/or their caregivers, families, and support networks. The field of stroke prevention is relatively nascent, and little is known about how to optimize health care systems so that providers prescribe evidence-based care for stroke prevention, patients have access to care to receive such services, adherence and control of risk factors are optimized, and patients are empowered to manage their own risk factors and make lifestyle changes, including eating healthy diets (high in fruits, vegetables, and whole grains and low in sodium and sugar-sweetened beverages), engaging in regular physical activity, not smoking, and limiting alcohol consumption. In the next several years, we will likely develop a better understanding of which strategies are effective for modifying vascular risk factors, and how to design and implement successful interventions. Key questions to be answered include optimal theoretical frameworks, delivery models, team composition, timing, dose, intensity, and frequency, taking into account cultural, sociodemographic, and regional differences in patient populations.

scholarly journals Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US

2020 ◽  
Vol 180 (10) ◽  
pp. 1328 ◽  
Author(s):  
Molly M. Jeffery ◽  
Gail D’Onofrio ◽  
Hyung Paek ◽  
Timothy F. Platts-Mills ◽  
William E. Soares ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Emergency Department Visits ◽  
The Us ◽  
Care Systems

The Role of Anti-obesity Drugs in Patients with Type 2 Diabetes

2013 ◽  
Vol 09 (02) ◽  
pp. 101 ◽  
Author(s):  
Priscilla Hollander ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Lifestyle Changes ◽  
Important Concern ◽  
Increased Risk ◽  
The Us ◽  
Patients With Diabetes ◽  
Obesity Drugs

The prevalence of diabetes continues to rise, following the rising rates of obesity. Obesity is not only associated with an increased risk for developing type 2 diabetes but also an elevated probability of developing long-term complications associated with the disease. Weight gain is also an important concern as a potential side effect of therapies that improve glycemic control in diabetes, including insulin therapy. As a result, patients with type 2 diabetes are at risk for a vicious circle of increasing weight and increasing insulin resistance, thus requiring further intensification of glycemic treatment. It is therefore important to address the problem of obesity in patients with type 2 diabetes. In 2012, the US Food and Drug Administration (FDA) approved two new anti-obesity medications: lorcaserin and phentermine/topiramate extended-release. Both agents have demonstrated clinically meaningful weight reduction as well as significant improvements in glycemic control in obese patients with diabetes. Liraglutide has also shown weight loss and improvements in glycemic control in patients with diabetes. Anti-obesity drugs, in conjunction with lifestyle changes, may play a valuable role in the management of diabetes.

scholarly journals Work stress of primary care physicians in the US, UK and German health care systems

2010 ◽  
Vol 71 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Johannes Siegrist ◽  
Rebecca Shackelton ◽  
Carol Link ◽  
Lisa Marceau ◽  
Olaf von dem Knesebeck ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Stress ◽  
Primary Care Physicians ◽  
Health Care Systems ◽  
German Health ◽  
The Us ◽  
Care Systems

Satisfaction with Primary Health Care and Confidence in General Practitioners: An Exploratory Comparison of US and UK Students

1993 ◽  
Vol 6 (2) ◽  
pp. 89-98
Author(s):  
Bodo B. Schlegelmilch ◽  
James M. Carman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Health ◽  
The Us ◽  
Care Systems ◽  
The Uk ◽  
Oriented System

This paper explores attitudes of university students towards two differently organised health services, ie the National Health Service in the UK and the more market oriented system in the US and analyses the level of confidence placed in primary care providers (GPs/family physicians) in both systems. Although major differences in the perception of the two health care systems are identified, hardly any differences emerge between the two countries in terms of the confidence patients place in their primary care providers.

Neurobiology of food choices-between energy homeostasis, reward system, and neuroeconomics

e-Neuroforum ◽  
2016 ◽  
Vol 22 (1) ◽  
Author(s):  
Laura Enax ◽  
Bernd Weber
Keyword(s):  
Energy Homeostasis ◽  
Health Care Systems ◽  
Reward System ◽  
Feeding Regulation ◽  
Control Food ◽  
Care Systems ◽  
Food Decisions ◽  
Short And Long Term ◽  
Control Food Intake ◽  
Internal And External Factors

AbstractThe rate of patients with obesity has been rapidly increasing, and this imposes a heavy economic burden on health-care systems. Food decisions, under the influence of different internal and external factors, lie at the core of this increasing health problem. Due to the biological necessity to consume sufficient amounts of food and to correctly regulate energy expenditure, there are different systems that control food intake. This article first focuses on neurobiological and hormonal foundations and explains various metabolic short- and long-term signals, such as leptin, insulin, and ghrelin. We then also present genetic factors, which directly or indirectly (via other genes or environmental influences) may affect nutritional status. Since the consumption of high-caloric foods is accompanied by dopamine release and the activation of the brain’s reward system, we will then present the interdependence of metabolic and reward systems. Last, we will present a neuroeconomic perspective that complements research on metabolic and hedonic feeding regulation.

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